Introduction:
Diabetes is a significant global health issue, projected to affect over 600 million people by 2030. Diabetic Nephropathy (DN) affects 40% of diabetics, leading to End Stage Renal Disease (ESRD) necessitating costly treatments like dialysis or transplantation. The emergence of Non-Proteinuric Diabetic Nephropathy (NPDN), affecting 20-40% of diabetics, poses increased cardiovascular and ESRD risks. While platelet inflammatory markers like Mean Platelet Volume (MPV) and Mean Platelet Volume to Lymphocyte ratio (MPVLR) serve as indicators of DN, their role in NPDN remains unexplored. We hypothesise that NPDN is a macrovascular complication and would show varied levels of inflammation compared to PDN.
Methods:
The cross-sectional observational study involved 198 participants arriving at the tertiary care centre divided among NPDN, PDN, diabetic and healthy groups. Demographic assessments and clinical investigations like Complete Blood Count, Renal Function Tests, HbA1c levels, and 24-hour Urine Protein assessment were recorded. The estimated Glomerular Filtration Rate was calculated using the CKD-EPI Creatinine Equation (2021). Data were recorded, cleaned and coded. Statistical analysis was performed using IBM SPSS Statistics 15.0, with descriptive statistics presented as mean ± SD. The two-tailed t-test assessed differences between the means of normally distributed data. Receiver-operating characteristic (ROC) curve analyses determined MPVLR and MPV cut-off values, sensitivity, and specificity for differentiating between nephropathy groups. Pearson correlation analysis assessed the variation of MPV and MPVLR with HbA1c levels and the duration of diabetes. Statistical significance was set at p < 0.05.
Results:
The study revealed a significant elevation of MPV and the MPVLR (MPV p<0.001, MPVLR p=0.005) in PDN compared to NPDN. These findings align with the literature, which indicates elevated platelet indices in diabetic nephropathy patients compared to diabetic patients without any complications. The ROC curve analysis demonstrated that MPVLR and MPV could effectively differentiate between PDN and NPDN, with MPV showing higher sensitivity and specificity (70.5% and 71.4%, respectively) compared to MPVLR (64.7% and 51.4%, respectively). Thus, our study supports the hypothesis that NPDN could most likely be a macrovascular complications, resulting in comparatively decreased platelet activation of PDN. The study found no significant correlation between MPV or MPVLR with HbA1c levels or diabetes duration. The results highlight the potential utility of MPV and MPVLR as quick and cost-effective biomarkers for distinguishing between PDN and NPDN, offering valuable clinical insights into managing diabetic nephropathy subtypes.
Conclusions:
In conclusion, the study provides solid evidence for the macrovascular pathogenesis hypothesis of NPDN. It demonstrates that MPV and MPVLR are valuable biomarkers for distinguishing between PDN and NPDN, with MPV showing higher sensitivity and specificity. These findings could facilitate faster and cost-effective clinical differentiation enhancing the management of DN.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.